Healthcare Provider Details

I. General information

NPI: 1114934726
Provider Name (Legal Business Name): GABRIELLA CHANCE CALDWELL-MILLER PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 CONNECTICUT AVE
GLEN ALLEN VA
23060-2376
US

IV. Provider business mailing address

1045 CONNECTICUT AVE
GLEN ALLEN VA
23060-2376
US

V. Phone/Fax

Practice location:
  • Phone: 804-836-6274
  • Fax:
Mailing address:
  • Phone: 804-836-6274
  • Fax: 309-662-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004375
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: